Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Utilization Management Clinical Trainer plays a vital role in onboarding and developing clinical staff to ensure high-quality, consistent, and compliant utilization review services. This position is responsible for designing and delivering training programs for new utilization review nurses and coordinators, as well as providing ongoing education and support to current team members. The Utilization Management Clinical Trainer also collaborates with other clinical trainers to create standardized training materials that support clinical consistency across roles at Alignment. In addition to leading training initiatives, the Utilization Management Clinical Trainer contributes to utilization review audits and interrater reliability (IRR) assessments to promote ac-curacy, quality, and alignment with internal policies, accreditation standards, and regulatory guidelines. This position enhances reviewer confidence, ensures peer alignment, and encourages a culture of continuous learning, which are essential elements in developing a high-performing clinical team.
This position builds and maintains strong collaborative partnerships with key partners in the Clinical Services organization including Care Management, Performance Improvement, Medical Management and Policy including Quality and Medical Review and Appeals, Pharmacy, and Provider Integration to identify, develop, implement, and monitor performance metrics related to UM Operations.
This position also builds strong collaborative partnerships internally and externally with key stakeholders and vendors to ensure that internal and external UM operations programs are well-coordinated and work cooperatively to achieve outcomes goals. Areas of direct responsibility include Medical Utilization Management including Inpatient Review & Prior Authorization, SNF concurrent review, and pre-service authorization process.
This position is primarily remote; however, in-person attendance at Alignment Health’s headquarters in Orange, CA is required approximately once per quarter for leadership meetings and team collaboration. Candidates located outside of California should expect periodic travel to the Orange office. Travel expenses are reimbursed in accordance with company policy.
Training and Onboarding
Audit & Interrater Reliability (IRR)
Team Support & Collaboration
Job Requirements:
Experience:
Education:
Licensure:
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $77,905.00 - $116,858.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
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